1.Urinary type IV collagen levels in diabetes mellitus
Pavai Sthaneshwar ; Siew-Pheng Chan
The Malaysian Journal of Pathology 2010;32(1):43-47
Type IV collagen is the principal component of glomerular basement membrane and messangial
matrix. Studies have shown increased levels of urinary type IV collagen (uIV) in diabetic patients
compared to healthy controls. The concentration of uIV increases gradually as diabetic nephropathy
progresses. Aim and method: This study was carried out to determine whether urinary type IV collagen
(uIV) can serve as an indicator of diabetic nephropathy. Using a sandwich enzyme immunoassay
technique, uIV excretion was determined in 30 type 2 diabetic patients with normoalbuminuria and
20 patients with microalbuminuria. Results: uIV excretion was signifi cantly increased in type 2
diabetics, in both normoalbuminuric and microalbuminuric patients, compared with healthy controls.
The increase in urinary type IV collagen was well correlated with the amount of urinary albumin
but not with HbA1C. Conclusion: Our fi ndings that uIV is higher in those with microalbuminuria
and correlates with albuminuria, support uIV as an indicator of diabetic nephropathy. Whether the
increased uIV excretion would predict the impending renal failure needs further confi rmation.
2.DiabCare 2013: A cross-sectional study of hospital based diabetes care delivery and prevention of diabetes related complications in Malaysia
Mafauzy Mohamed ; Zanariah Hussein ; Avideh Nazeri ; Siew Pheng Chan
The Medical Journal of Malaysia 2016;71(4):177-185
Aims: The aim of the study was to re-evaluate the
relationship between hospital based diabetes care delivery
and prevention of complications.
Methods: DiabCare is an observational, non-interventional,
cross-sectional study of hospital-based outpatient diabetes
care.
Results: A total of 1668 patients participated in the study:
mean age 57.8 ± 11.0 years, duration of diabetes 13.0 ± 8.6
years, and duration of insulin treatment 5.6 ± 5.5 years. Mean
weight was 74.3 ± 16.6 kg (BMI 29.1 ± 5.8 kg/m2). The
majority of patients were female (53.6%) and the largest
ethnic group was Malay (51.3%), followed by Indian (21.9%)
and Chinese (20.1%). The percentage of patients with HbA1c
< 6.5% (< 42 mmol/mol) and < 7.0% (< 53 mmol/mol) was
12.2% and 23.8%, respectively (mean HbA1c 8.52 ± 2.01% [70
± 22 mmol/mol]). The proportion of patients using insulin
was 65% at a total daily dose of 60 ± 37 IU. One or more
episodes of hypoglycaemia were reported by 39% (n=658) of
patients within the previous three months. The risk of any
hypoglycaemia was associated with the use of insulin (odds
ratio [OR 3.26, 95% CI 2.59–4.09]), and total daily insulin
dose (OR 1.04, 95% CI 1.01–1.07 per 10 IU increase). Mean
HbA1c had not changed significantly between DiabCare
cohorts 2008 and 2013 (p=0.08).
Conclusions: Despite evidence of improving processes of
diabetes care, glycaemic control and the prevalence of many
diabetes related complications were unchanged.
Diabetes Mellitus, Type 2
3.Diabetes care model in Malaysia
Journal of the ASEAN Federation of Endocrine Societies 2015;30(2):100-104
With the highest prevalence of diabetes in the region, Malaysia faces a massive task ahead to care for its people
afflicted with the disorder. For a successful Diabetes Care model to work, it requires a well-established functioning
multidisciplinary team comprising Endocrinologists/Physicians/Family Medicine Specialist Physicians, Diabetes Nurse
Educators, Dietitians, Pharmacists, and others such as Podiatrists are needed to provide broad ranging services.
Although we have many such individuals trained and working independently, these services are fragmented. What is
required is coordination and integration of these services to enable patients’ access in a timely manner. The Disease
Control Division, Ministry of Health continues to play a central role – coordinating and funding these initiatives. What is
desperately needed are more certified Diabetes Nurse Educators to manage the overall care of the patients as well as
to provide key diabetes education that enable patient-empowerment to improve self-care, compliance, and ultimately
result in better lives.
Patient Participation
4.Letter: Sarcopenia and vertebral fracture
Fen Lee HEW ; Siew Pheng CHAN ; Swan Sim YEAP
Osteoporosis and Sarcopenia 2018;4(4):151-151
No abstract available.
Sarcopenia
5.Response to the Editor: Reply on “Combined orthogeriatric and fracture liaison service for improved postfracture patient care”.
Swan Sim YEAP ; Fen Lee HEW ; Siew Pheng CHAN
Osteoporosis and Sarcopenia 2017;3(3):160-160
No abstract available.
Humans
6.Prevalence of glucose intolerance, and associated antenatal and historical risk factors among Malaysian women with a history of gestational diabetes mellitus.
Wai Fong CHEW ; Pendek ROKIAH ; Siew Pheng CHAN ; Winnie Siew Swee CHEE ; Lai Fun LEE ; Yoke Mun CHAN
Singapore medical journal 2012;53(12):814-820
INTRODUCTIONWomen with previous gestational diabetes mellitus (PGDM) are at increased risk of future glucose intolerance. This study aimed to determine the prevalence of prediabetes and type 2 diabetes mellitus (T2DM), and the associated antenatal and historical risk factors among women with PGDM.
METHODSThis was a cross-sectional study conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. A 75-g 2-hour oral glucose tolerance test was performed in a cohort of multiethnic women with PGDM. Body mass index, waist and hip circumferences, fasting lipid profile and blood pressure were obtained. Data pertaining to the index gestational diabetes mellitus (GDM) were obtained from medical records and interviews.
RESULTS448 women were enrolled in the study. The prevalence of prediabetes and T2DM was 26.2% and 35.5%, respectively. On multinomial logistic regression analysis, fasting plasma glucose at diagnosis of index GDM and duration lapse after index GDM were shown to be significantly higher in women with isolated impaired fasting glucose (IFG), combined IFG/impaired glucose tolerance and T2DM, as compared to women with normal glucose tolerance (p < 0.05). 2-hour plasma glucose at diagnosis of index GDM was significantly higher only in women who progressed to T2DM when compared to those that remained normal glucose tolerant (p < 0.05).
CONCLUSIONIn this study, duration lapse after index GDM, fasting plasma glucose and 2-hour plasma glucose at diagnosis of index GDM were important risk factors for early identification of women at high risk for future glucose intolerance. These may be useful for developing potential preventive strategies.
Adult ; Blood Glucose ; metabolism ; Body Mass Index ; Cross-Sectional Studies ; Diabetes, Gestational ; blood ; Female ; Glucose Intolerance ; blood ; epidemiology ; etiology ; Glucose Tolerance Test ; Humans ; Malaysia ; epidemiology ; Postpartum Period ; blood ; Prediabetic State ; epidemiology ; etiology ; Pregnancy ; Prevalence ; Risk Factors
7.A summary of the Malaysian Clinical Guidance on the management of postmenopausal and male osteoporosis, 2015.
Swan Sim YEAP ; Fen Lee HEW ; Premitha DAMODARAN ; Winnie CHEE ; Joon Kiong LEE ; Emily Man Lee GOH ; Malik MUMTAZ ; Heng Hing LIM ; Siew Pheng CHAN
Osteoporosis and Sarcopenia 2016;2(1):1-12
AIM: This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with osteoporosis (OP), using the best available evidence. METHODS: A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on OP and its assessment, diagnosis and treatment, from 2011, to update from the 2012 edition. The studies were assessed and the level of evidence assigned. For each statement, studies with the highest level of evidence were used to frame the recommendation. RESULTS: This article summarizes the diagnostic and treatment pathways for postmenopausal and male OP, while addressing the risk-benefit ratio for OP treatment. Recognising the limitation of only depending on bone mineral density in assessing fracture risk, a move to assess 10 year fracture risk using tools such as FRAX, is recommended as a guide to decision-making on when to start treatment. A re-evaluation was done of the position of calcium supplementation and on the importance of vitamin D. There has been concern about the potential adverse effects of the long-term usage of bisphosphonates, which have been discussed fully. Algorithms for the management of postmenopausal and male OP have been updated. CONCLUSIONS: Adequate intake of calcium (1000 mg from both diet and supplements) and vitamin D (800 IU) daily remain important adjuncts in the treatment of OP. However, in confirmed OP, pharmacological therapy with anti-resorptives is the mainstay of treatment in both men and postmenopausal women. Patients need to be regularly assessed while on medication and treatment adjusted as appropriate.
Bone Density
;
Calcium
;
Diagnosis
;
Diet
;
Diphosphonates
;
Female
;
Humans
;
Malaysia
;
Male*
;
Osteoporosis*
;
Vitamin D
8.An update of the Malaysian Clinical Guidance on the management of glucocorticoid-induced osteoporosis, 2015.
Swan Sim YEAP ; Fen Lee HEW ; Premitha DAMODARAN ; Winnie CHEE ; Joon Kiong LEE ; Emily Man Lee GOH ; Siew Pheng CHAN
Osteoporosis and Sarcopenia 2017;3(1):1-7
OBJECTIVES: This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with glucocorticoid-induced osteoporosis (GIO), using the best available evidence. METHODS: A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on GIO and its assessment, diagnosis and treatment, from 2011, to update from the 2012 edition. The studies were assessed and the level of evidence assigned. For each statement, studies with the highest level of evidence were used to frame the recommendation. RESULTS: Consider treatment early in all patients on glucocorticoids (GC) as fracture risk increases within 3–6 months of starting GC. The decision to start treatment for GIO depends on the presence of prior fracture, category of risk (as calculated using FRAX), daily dose and duration of GC treatment, age, and menopausal status. General measures include adequate calcium and vitamin D intake and reducing the dose of GC to the minimum required to achieve disease control. In patients on GC with osteoporotic fractures or confirmed osteoporosis on dualenergy X-ray absorptiometry, bisphosphonates are the first-line treatment. Treatment should be continued as long as patients remain on GC. Algorithms for the management of GIO in both pre- and post-menopausal women and men have been updated. CONCLUSIONS: In post-menopausal women and men above 50 years, bisphosphonates remain the mainstay of treatment in GIO. In pre-menopausal women and men below 50 years, bisphosphonates are recommended for those with a prevalent fracture or at very high risk only.
Absorptiometry, Photon
;
Adrenal Cortex Hormones
;
Calcium
;
Diagnosis
;
Diphosphonates
;
Female
;
Glucocorticoids
;
Humans
;
Malaysia
;
Male
;
Osteoporosis*
;
Osteoporotic Fractures
;
Vitamin D
9.A summary of the Malaysian Clinical Practice Guidelines on the management of postmenopausal osteoporosis, 2022
Terence Ing WEI ONG ; Lee Ling LIM ; Siew Pheng CHAN ; Winnie Siew SWEE CHEE ; Alan Swee HOCK CH’NG ; Elizabeth GAR MIT CHONG ; Premitha DAMODARAN ; Fen Lee HEW ; Luqman bin IBRAHIM ; Hui Min KHOR ; Pauline Siew MEI LAI ; Joon Kiong LEE ; Ai Lee LIM ; Boon Ping LIM ; Sharmila Sunita PARAMASIVAM ; Jeyakantha RATNASINGAM ; Yew Siong SIOW ; Alexander Tong BOON TAN ; Nagammai THIAGARAJAN ; Swan Sim YEAP
Osteoporosis and Sarcopenia 2023;9(2):60-69
Objectives:
The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP).
Methods:
A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation.
Results:
This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate.
Conclusions
The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.
10.Use of SGLT-2 Inhibitors in Patients with Type 2 Diabetes Mellitus and Abdominal Obesity: An Asian Perspective and Expert Recommendations
Wayne Huey Herng SHEU ; Siew Pheng CHAN ; Bien J MATAWARAN ; Chaicharn DEEROCHANAWONG ; Ambrish MITHAL ; Juliana CHAN ; Ketut SUASTIKA ; Chin Meng KHOO ; Huu Man NGUYEN ; Ji LINONG ; Andrea LUK ; Kun Ho YOON
Diabetes & Metabolism Journal 2020;44(1):11-32
The prevalence of obesity in Asia is of epidemic proportions, with an estimated 1 billion overweight/obese individuals in the region. The majority of patients with type 2 diabetes mellitus (T2DM) are overweight/obese, which increases the risk of cardiorenal outcomes in these patients; hence, sustained reductions in body weight and visceral adiposity are important management goals. However, most of the glucose-lowering therapies such as insulin, sulfonylureas, glinides, and thiazolidinediones induce weight gain, which makes the management of overweight/obese T2DM patients challenging. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the only oral glucose-lowering agents that have been shown to reduce body weight and visceral adiposity. In addition, SGLT-2 inhibitors therapy reduces ectopic fat deposition and improves adipose tissue function and weight-related quality of life. In this article, we aim to consolidate the existing literature on the effects of SGLT-2 inhibitors in Asian patients with T2DM and to produce clinical recommendations on their use in overweight or obese patients with T2DM. Recommendations from international and regional guidelines, as well as published data from clinical trials in Asian populations and cardiovascular outcomes trials are reviewed. Based on the available data, SGLT-2 inhibitors represent an evidence-based therapeutic option for the management of overweight/obese patients with T2DM.